Pathology of Treated GI Neoplasia

Transcription

1 Pathology of Treated GI Neoplasia Pathology section seminar Liverpool DDF meeting Tuesday 19 th June 2012 at14:00-15:15 Venue: Hall 11c in the ACC Presenters: Phillip Kaye, Adrian Bateman, Shaun Walsh, Norman Carr, Judy Wyatt

2 Treated Barrett s Philip Kaye NUH

3 55 year old man on long standing Barrett s surveillance

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6 62 year old man EMR for HGD

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8 50 year old man- nodule post RFA for LGD

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10 p53

11 BSG/DDF 2012 Pathology Slide Seminar Dr Adrian C Bateman Southampton University Hospitals NHS Foundation Trust Southampton Cellular Pathology

12 History 56 year old man Refractory dysphagia following treatment for upper GI malignancy Gastrectomy performed Sections are from stomach wall Southampton Cellular Pathology

13 Mucosal aspect Southampton Cellular Pathology

14 Serosal aspect Southampton Cellular Pathology

15 Muscularis propria Southampton Cellular Pathology

16 GIST treated with TKIs Three cases Dr Shaun Walsh Ninewells Hospital Dundee

17 Case 1 Male patient, age 43 yrs. Dx with gastric GIST 1 year ago KIT positive on biopsy. Tyrosine kinase therapy for 10 months to shrink tumour and avoid total gastrectomy Tumour decreased very little in size but limited gastrectomy achieved Any evidence of response and can you do mutation analysis now please?

18 Resected tumour after TKI

19 Resected tumour after TKI

20 Case 2 Female age 49yrs. Dx. with small bowel GIST 1 yr. ago R0 resection. Tumour focally KIT positive. Tx. with Tyrosine Kinase inhibitor for one yr. Now has recurrence Can you do mutation analysis please?

21 Resected tumour after TKI

22 Resected tumour after TKI

23 Case 3 Female age 62 yrs. Large Gastric GIST. Liver metastases. KIT, DOG-1 positive core biopsy. Treated with TKI s 6 months, no response New peritoneal metastases sampled Any evidence of response?

24 Primary tumour untreated

25 New peritoneal metastasis

26 Pathology of treated colorectal carcinoma Norman Carr

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30 Chemoradiation effects Fibrosis Necrosis Acellular mucin Calcification

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32 Modified RCRG grading system (Bateman AC et al) 1. Malignant epithelium <5% 2. Malignant epithelium 5 to 50% 3. Malignant epithelium >50%

33 RCPath guidelines staging For tumour staging following neoadjuvant therapy, only the presence of tumour cells in the surgical specimen is taken to determine the stage. Fibrosis, haemorrhage, necrosis, inflammation and acellular mucus are ignored. Cases with complete regression are therefore recorded as ypt0

34 References Bateman AC et al. Rectal cancer staging post neoadjuvant therapy how should the changes be assessed? Histopathology 2009; 54: Chetty R et al. A multi-centre pathologist survey on pathological processing and regression grading of colorectal cancer resection specimens treated by neoadjuvant chemoradiation. Virchows Arch 2012; 460:151-5 Dworak O et al. Pathological features of rectal cancer after preoperative radiotherapy. Int J Colorectal Dis 1997; 12:19-23 Williams GT et al. Dataset for Colorectal Cancer (2nd edition). London: Royal College of Pathologists, 2007

35 Pathology of treated liver tumours Judy Wyatt

36 Mrs KM 28F Presented with bulky liver metastases, CK20+ve subsequently sigmoid primary identified. Treated with FOLFOXIRI irinotecan, oxaliplatin, 5FU very good response. Right trisectionectomy and segment 2&3 metastasectomies performed at same time as anterior resection of rectum ypt3, ypn1, ypv1, ypr0, TRG2 Liver: Right trisectionectomy, segments 4-8, 1,170kg, 7 tumours 5-70mm. Left metastasectomies x2, 1.2g and2.1g, 2 tumours, 7mm and 10mm lesions

37 KM right

38 KM rectum

39 KM right

40 KM left

41 KM right

42 KM right

43 KM right VG

44 Mr PE, 27M August 2008: inoperable carcinoma of upper rectum with bulky bilateral liver metastases. Sept Feb 2008:Treated with oxaliplatin and cetuximab. Good response but still inoperable. March 2009: Candidate for SIRT treatment with aim of surgery if further response. June 2009: SIRT July 2009: nausea, vomiting, ascites, 3 weeks after treatment. Deteriorated and died 3 weeks later. Consent autopsy:

45 PE left right

46 PE

47 PE

48 PE

49 PE

50 PE

51 PE VG